Yemeng Chen, New York College of Traditional Chinese Medicine
Abstract: This article is a comprehensive introduction to the gen- eral situation of education and practice of acupuncture and Chinese herbal medicine in the United States. Education system which has been established for Acupuncture and Chinese herbal medicine in the United States and its admission requirements, curriculum, and professional competencies have been formulated. The National Certification Commission for Acupuncture & Oriental Medicine (NCCAOM) Examination is one of the main require- ments for receiving an acupuncture license in all states (except California). The article introduces what is required for examination eligibility, its format, modules, and content, as well as contin- uing education requirements for NCCAOM diplomates. At the same time, it introduces the status quo of acupuncture legislation in the United States, the scope of practice, and the requirements and procedures for license application.Acupuncture in the United States has been been adopted as a native part of the healthcare system, and it is likely that the acupuncture development will enter a new stage.
KEYWORDS: United States; Acupuncture; Chinese herbal medicine; Education; NCCAOM Exam; Acupuncture License. After more than half a century of development, acupuncture has become an integral part of the American healthcare system. Today, integrative medicine is a major trend, and the concept of “patient-centered care” has been adopted in medical practice. In the crisis caused by opioid drug abuse, the promotion of nonpharmacological pain management has reached a consensus among legislatures, government agencies, and medical research institutions. Acupuncture has played an important role on this initiative (1) . Outside of mainland China, the United States is con- sidered as the largest, most systematic, and most influential in its education and practice of acupuncture and Chinese herbal medicine (2) . This article is an overview of this development.
1. Education of Acupuncture & Chinese Herbal Medicine in the United States
Acupuncture education in the United States began in the early 1970s and the New England School of Acupuncture was established in 1976, which was the first acupuncture school officially approved by the government in US history (3). As acupuncture has gradually gained legislative status in various states, acupuncture schools have been booming, and have developed distinct characteristics due to different traditions. At present, there are 52 acupuncture schools or colleges (departments) accredited by the Accreditation Commission for Acupuncture and Herbal Medicine (ACAHM), which is also recognized by the US Department of Education.
1.1 Admission requirements. At present, the entry-level of education in acupuncture and Chinese herbal medicine in the United States is a master’s degree program. The admission requirement is completion of at least 2 years of undergraduate study (60 credits) in American accredited colleges or universities, while professional doctoral programs require at least 3 years of undergraduate study (90 credits). Credits for undergraduate study received in a foreign country must be evaluated by a recognized educational evaluation service. International students whose native language is not English must also demonstrate his/her proficiency in English level, either holding a four-year U.S. high school diploma, or having two years of undergraduate study at an accredited college or university in the U.S. (or foreign countries in an English-language instruction), or having TOEFL score of 61 or IELTS score of 6, or achieving Level 6 of the China English Language Standard Test.
1.2 Curriculum. There are three educational levels of acupuncture and Chinese herbal medicine in the United States.
The Master’s degree in Acupuncture is the current professional entry-level, at least 3 academic years in length. Curriculum includes East Asian medical theory, diagnosis and treatment techniques in acupuncture and related studies, biomedical clinical sciences, professional development including counseling, communication, ethics, and practice management, and clinical training. The ACAHM’s minimum standards for entry-level education must be at least 105 credits (1905 hours), of which clinical training should be at least 22 credits (660 hours). The 4-year Master of Acupuncture with a Chinese herbal medicine specialization (or Master of Acupuncture with Chinese herbal medicine) program covers both acupuncture and Chinese herbal medicine, which should be a total of no less than 146 credits (2625 hours) with instruction in integrated acupuncture and herbal clinical training. After graduating from a master’s degree in acupuncture, students who want to study Chinese herbal medicine can enroll in a Certificate in Chinese Herbal Medicine program which is a minimum of 41 credits of instruction. The actual number of instruction hours or credits in each college is much higher than those minimum standards.
The Professional Entry Level Doctorate (D.AC.) is a 4-year program. Doctoral education as a professional entry standard is the trend of acupuncture and Chinese herbal medicine education in the United States. It is estimated that it will take 5-10 years to be fully implemented.
The Advanced Practice Doctoral (DAOM) program is a 2-year postmaster clinical doctoral education, which is mainly focused on specialties like pain management, gynecology, or oncology, which varies from school to school.
1.3 Professional Competencies. Professional training not only requires the above-mentioned minimum number of hours of instruction, but graduates must also meet the corresponding competencies required by the college’s educational goals, especially clinical competencies. The professional competence formulated by ACAHM includes three aspects, Patient Care (foundational knowledge, critical thinking professional judgment, history taking and physical examination, East Asian Medicine-based diagnosis, case management, East Asian Medi- cine-based treatment, emergency management, and advanced diagnostic studies), System-Based Medicine (education and communication, patient care system, collaborative care) and Professional Development (education and communication, formulating and implementing plans for individual professional development, incorporating scholarship, research and evidence-based medicine/ evidence-based practice into patient care). Each of these competencies includes different domains and specific sub-items. Among them, “case management” is a new concept. In this do- main, students must demonstrate the ability such as awareness of and familiarity with culture competency (understanding the cultural background of different ethnic groups and LGBTQ+ community), communicating with other healthcare providers to determine an appropriate plan of care, providing a report of findings and health care plan to the patient, creating reports and professional correspondence relevant to the care of patients, identifying a range of referral resources and the modalities they employ, and using information systems in case management. It shows that the clinical competencies in training are of great importance to integrative medicine, safety, and regulatory compliance.
2. National Board Exam for Acupuncture & Chinese Herbal Medicine
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) is responsible for the national board exam for Acupuncture and Chinese herbal medicine. Except California, all states which have legalized acupuncture use NCCAOM exams as an important aspect of the credential review in the process of applying for an acupuncture license.
2.1 Eligibility and Exam Format. Graduates from regular acupuncture schools accredited by ACAHM are eligible to participate in the exams. Graduates from TCM colleges in mainland China can first contact NCCAOM and have their transcripts evaluated by its designated educational evaluation agency. Generally, the credits of graduates from the Department of Acupuncture and Moxibustion or Department of Chinese Medicine in TCM universities in China basically meet the professional entry-level standards recognized by ACAHM, or they may only need to make up some credits such as ethics and clinical consultation.
Exams are taken online. When an NCCAOM Authorization to Test Letter is received, applicants can directly contact the nearest Pearson VUE Testing Center to schedule an examination time. Different modules can be scheduled at different times.
2.2 Examination modules and contents. The NCCAOM Examination has four modules, each having 100 multiple-choice questions with a 2.5-hour time limit. The exams are administered in computer-adaptive format, that is, they adjust the difficulty of the next exam questions in real-time according to the performance on the answers given so far. The Foundation of Oriental Medicine module covers the contents of clinical examination methods, assessment, analysis, and differential diagnosis based upon acupuncture and Chinese medicine theory, and treatment principles and strategy. The Acupuncture with Point Location module tests safety and professional responsibilities, treatment plan, treatment techniques, and acupuncture point location. The Biomedicine module covers the clinical application of biomedical sciences(e.g., anatomy, physiology, pathology, pathophysiology), pharmacology, and nutrients and supplements, patient history and physical examination, clinical assessment process, and safety and professional responsibilities. The Chinese Herbology module includes content on the safety and quality of Chinese herbs, treatment planning and strategy, and patient management. If you pass the first three exams, you will be awarded a Diplomate of Acupuncture; if you pass all four exams, you will be awarded a Diplomate of Oriental Medicine. Before taking the examinations, a Clean Needle Technique (CNT) Certificate is required.
The exam has a clear content outline and a detailed bibliography. The Acupuncture with Point Location Content Outlines has an appendix of 27 extra points. The Biomedicine Content Outline has three appendices including pharmaceuticals, nutrients and supplements, and medical conditions. The Chinese Herbology Content Outline listed 272 Chinese individual herbs and 162 Chinese herbal formulas.
2.3 Continuing education requirements for NCCAOM Diplomates. All NCCAOM diplomates should renew their certificates every four years and provide 60 points for Professional Development Activities (PDA). They can update and enrich relevant knowledge in the core categories of Oriental Medicine Foundation Theory, Acupuncture, Chinese Herbology and Biomedicine/Western Medicine by attending lectures. When it is time to renew, it is specified to attend a practice safety lecture (2 points) and professional ethics lecture (2 points) during the 4-year time period and a current Cardiopulmonary Resuscitation (CPR) Certificate (4 points) among 60 PDAs.
3. Acupuncturist Practice and License in the United States
3.1 Overview of Acupuncture Legislation in the United States. In 1973, the legal practice of acupuncture and Chinese herbal medicine were successfully legislated in Nevada, which opened a new chapter for its professional development in the United States. Afterward, the Practice Acts for acupuncture have gradually passed in various states. This kind of grassroots lobbying and legislative campaign was very difficult but successful. So far, acupuncture has legal status in 47 states plus Washington, D.C., only South Dakota, Oklahoma, and Alabama do not have legislation in place.
3.2 Scope of Acupuncture Practice. In the United States, special attention should be paid to the scope of practice of acupuncture licenses in each state(5) . The definition of acupuncture profession with practice scope of acupuncturists varies from state to state, while it includes Chinese herbal medicine in California, Florida, and New Mexico, and it also includes injection therapy in Florida and Colorado. According to the definition of the profession of acupuncture in New York State Law, it is the treatment, by means of mechanical, thermal or electrical stimulation, effected by the insertion of needles or by the application of heat, pressure or electrical stimulation, at a point or combination of points on the surface of the body predetermined on the basis of the theory of the physiological interrelationship of body organs with an associated point or combination of points for disease, disorders and dysfunctions of the body for the purpose of achieving a therapeutic or prophylactic effect. The law also described that the profession of acupuncture includes the recommendation of dietary supplements (like herbal remedies) and natural products. (6)
3.3 Requirements and procedures for license application. Those who hold a diploma from a regular acupuncture college and obtain an NCCAOM Diplomate of Acupuncture (or Oriental Medicine) are eligible to apply for an acupuncture license in various states which have an acupuncture practice act. California only accepts individuals who graduated from colleges recognized by the California Acupuncture Board and passed the California Acupuncture Licensing Exam. In the states that have licensure there are governmental agencies that administrate acupuncture licenses. Log on the website of the corresponding acupuncture board of the state government to learn about the requirements and application procedures for acupuncture licenses. The state acupuncture board usually contacts the college or university directly to verify 60 credits of pre-professional study and professional acupuncture study. NCCAOM test results will also be delivered directly by NCCAOM to the state board. Some states have other regulations. For example, non-Florida acupuncture school graduates who apply for a license in Florida must also complete additional training which includes 15 hours supervised instruction in universal precautions applicable to needling techniques, 20 hours on the laws and rules of practice in Florida, and 60 hours for an injection therapy course.
Conclusion
Acupuncture is an emerging profession with potential in the US healthcare system. The Department of Labor has promulgated a new occupational code 29- 1291.00 for acupuncture, and it is expected that there will still be an average growth of 4-7% in the next few years (7) . Through the efforts of several generations, the acupuncture profession now has a well-established system of entry-level standards, college accreditation, curriculum and professional competencies, board exam system, and license administration that reflect a true adoption of the acupuncture profession in the United States. With the continuous expansion of integrated medicine, the further implementation of non-pharmacological pain management, and more acceptance of acupuncture in the insurance industry, the professional development of acupuncture will enter a new stage.
References
1.Chen Y. Acupuncture: An Important Modality in Non-Pharmacological Pain Management. J Complement Med Alt Healthcare. 2018; 5(1):555653. DOI: 10. 19080/JCMAH.2018.05.555653.
2. Boli Zhang Editor-in-Chief. Overview of World Chinese Medicine Education. China Press of Traditional Chinese Medicine, Beijing. 2019, pp.83-88. (In Chinese)
3. Yemeng Chen. A Perspective of Acupuncture Education in the United States. J Complement Med Alt Healthcare. 2019; 9(5): 555773. DOI: 10. 19080/JCMAH.2019.09.555773
4.Directory of Accredited/Pre-accredited Programs and Institutions. https://acahm.org/directory-menu/directory/[Accessed on February 8, 2023]
5. A look at American Chinese medicine education and Chinese medicine practitioners practicing in the United States—Interview with Yemeng Chen, President of the New York College of Traditional Chinese Medi- cine. Kailin Zhou, Qing Wu, et al. Guiding Journal of Traditional Chinese Medicine. 25(15):1-3, 2019 (In Chinese)
6.New York State Education Law, Article 160, Acupuncture. https:// www.op.nysed.gov/professions/acupuncture/laws-rules-regulations/ article-160[Accessed on February 8, 2023]
7.Acupuncturists (29- 1291.00). O*Net OnLine. https:// www.onetonline.org/link/summary/29-1291.00?redir=29-1199.01
(Accessed on February 10, 2023)
